City of Chickasha 
 117 North 4th Street
 Chickasha , Ok 73018
SAFE ROOM REGISTRATION 

Registration Form

This Safe Room Registration Form is provided as a way for residents to inform the Chickasha Emergency Management Agency where their safe room or shelter is located. This information will be listed in a database that will be used in the event of a disaster to help the City determine where people may be trapped.
The information is kept confidential and will not be shared with individuals, companies or other agencies.

It is very important that you enter the information correctly.
Please review the information before you press the submit button.

ALL BLANKS SHOULD BE COMPLETED.
(IF YOU HAVE PROBLEMS SUBMITTING THE FORM, PLEASE CONTACT THE EMERGENCY MANAGEMENT OFFICE AT 405-222-6010)

Please fill out the following information and press the SUBMIT button.
Thank you for taking the time to provide this valuable life saving information.


Name:

Shelter Address: (NO P.O. Box Numbers)

City:(This form is for Chickasha Residents Only)

State: (OK)

Zip:

Phone Number: (xxx-xxx-xxxx)

E-mail Address:

Average number of people that will use the shelter:

Location and description of the shelter on the property (Be specific):
(Back yard, garage, bedroom, square footage, under storage building, year built, etc.)

 
Please select the item from each column that best describes your shelter.
SHELTER TYPE MATERIAL DOOR TO SHELTER LOCATED
Under Ground  Concrete Outside all Buildings
Above Ground Steel Inside a Building

Comments:

During the processing of this information, Staff will visit the property to obtain a Global Positioning System (GPS) reading so the property may be located if all of the landmarks are been destroyed during a disaster. Staff will not need access to your property or the shelter during this process.

Please visit the Emergency Management page for information on disaster preparedness.

SAFE ROOMS - Taking Shelter From The Storms

Home Page | Action Center | Information Request | Phone Numbers | E-Mail